Friday, August 18, 2017

Dialectic Behavioral Therapy May Lead to Improvements in Children With Disruptive Mood Dysregulation Disorder

There are no established treatments for disruptive mood dysregulation disorder (DMDD), a disorder characterized by chronic irritability and severe, recurrent outbursts in children. A study in the Journal of the American Academy of Child and Adolescent Psychiatry suggests dialectical behavioral therapy for children (DBT-C) may offer an advantage over individual therapy for preadolescent children with the disorder.

“Emotion regulation, defined as intrinsic capabilities individuals use to modulate the experience and expression of emotions based on internal or external demands, appears to be a core deficit in DMDD,” wrote Francheska Perepletchikova, Ph.D., of Weill Cornell Medical Center in New York and colleagues. “DBT is an empirically validated therapy designed to treat emotional regulation, suicidal thoughts, and non-suicidal self-injury associated with borderline personality disorder.”

For the study, Perepletchikova and colleagues randomly assigned 43 children aged 7 to 12 to DBT-C or treatment as usual (TAU) over 32 weeks. DBT-C consisted of weekly, 90-minute sessions conducted individually with each family; sessions were divided into child counseling, parent training, and skills training with parents and children. Children in the TAU group received up to 32 weeks of individual therapy, with each clinician determining session duration, frequency, and treatment approach. Assessments were conducted at the beginning of the study, followed by every 8 weeks until the end of 32 weeks, and again at a follow-up three months later.

After 32 weeks, the rate of positive response (“much improved” or “very much improved” on the Clinical Global Impressions Improvement Scale) was 90.4% for children receiving DBT-C and 45.5% for those receiving TAU. Children receiving DBT-C also showed higher rates of symptom remission (52.4% vs. 27.3%) and lower use of psychiatric medications (19.1% vs. 54.4%).

The DBT-C group also had much higher retention than the TAU group, though the authors noted this may have been due to the fact DBT-C was provided free of charge while TAU participants had to pay through insurance.

“A confirmatory efficacy trial is needed with a more structured TAU, with built-in strategies for retention and without requirement for payment,” the authors wrote. “Further research needs to examine the effects of DBT-C on specific outcomes, including depression and anxiety, as well as ... mediating factors, including emotion regulation, creation of validating environment, and treatment duration.”

Disclaimer

The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.